- Lead the Travel Claims Risk Management Team of eight covering high-risk medical and non-medical claims, denials, appeals, sensitive and escalated files, legal and media threats, regulatory inquiries, and large-loss oversight
- Lead review of high-value and complex travel claims and make or endorse financially, regulatorily, or reputationally significant decisions
- Set standards for written decision reasoning and manage work based on age and claim value
- Act as escalation point for claimant complaints, legal and media threats, and regulator enquiries
- Partner with Audit and Operations on monthly audits across Affinity and Group Benefits travel business
- Convert audit findings into process changes, training, administrator handling standards, and automation backlog improvements
- Establish the recovery baseline and connect audit findings with recoveries
- Build and maintain live operational reporting on intake, assignment wait time, review time, open work, overturn rates, and audit findings
- Bring traceable analysis to monthly operating reviews and executive discussions
- Own the Travel Claims scope of the transformation programme, including backlog prioritization, process definitions, planning, demonstrations, testing, go-live, and stabilization
- Assess automation tools, including medical-record summarization, and define appropriate automation and human decision boundaries
- Own risk and control oversight of the third-party administrator handling travel claims
- Set, document, and test vendor control expectations, approval authorities, and escalation rules
- Run weekly and monthly operational forums, quarterly and mid-year scorecards, and annual licensing, case-fee, and recovery reviews
- Own the vendor issue and corrective-action pipeline and maintain an accurate vendor risk position
- Lead, coach,



and develop a team of eight through role changes and automation-driven changes in work
- Build team capability with data and AI tools, set performance expectations, and develop succession depth
- Report to the Director, Affinity Claims, Canada Segment, and collaborate with Audit and Operations, risk, compliance, vendor management, transformation, and Affinity Operations leadership

Requirements

- Post-secondary education in a business, health, analytics, or insurance discipline, or an equivalent combination of education and experience
- Five or more years leading a claims, risk, or audit team
- Experience leading people through a significant change to how work is done
- Strong technical grounding in travel or health claims and medical case management
- Sound judgment on high-value and complex decisions
- Demonstrated use of data to run an operation
- Confidence with Excel and a reporting tool such as Power BI
- Experience as a business owner, product owner, or equivalent on a delivery programme
- Backlog ownership, user acceptance testing, and go-live decision experience
- Practical experience applying AI or automation tools to operational work
- Understanding of controls, error tolerance, and human decision points in automation
- Proven vendor relationship management experience with material outsourced or third-party relationships
- Experience with performance conversations, remediation, and maintaining vendor relationships
- Risk, control, and audit experience, including defining and testing controls, evidencing failures,



documenting findings, and completing remediation
- Experience working with first- and second-line risk partners and internal and external audit
- Robust vendor governance experience, including service levels, scorecards, issue and corrective action tracking, and upward risk reporting
- Strong written and verbal communication skills, including presenting results and recommendations to senior leaders
- Preferred: experience automating manual processes while maintaining or improving quality
- Preferred: familiarity with fair treatment of customers, complaint handling, and regulator enquiries in a Canadian insurance setting
- Preferred: familiarity with Canadian financial-services outsourcing and third-party-risk expectations
- Nice to have: bilingual French and English

Core Competencies

Demonstrates strong leadership in managing a Travel Claims Risk Management Team, with expertise in high-value claims, regulatory compliance, and vendor relationship management. Proficient in utilizing data and automation tools to enhance operational efficiency and decision‑making processes.

Highest-signal resume keywords

- Travel Claims Management
- Risk Management
- Vendor Relationship Management
- Data Analysis
- Automation Tools

Hard Skills

- Claims Management
- Risk Assessment
- Audit Experience
- Medical Case Management
- User Acceptance Testing
- Backlog Ownership
- Performance Tracking
- Regulatory Compliance
- Decision Making
- Process Improvement

Soft Skills

- Leadership
- Communication
- Judgment
- Coaching
- Collaboration

Industry Keywords

- Insurance
- Canadian Financial Services
- Third-Party Risk
- Customer Complaint Handling
- Operational Reporting

Tools & Technologies

- Excel
- Power BI
- AI Tools
- Reporting Tools
- Automation Software

📌 Manager, Travel Claims Vendor Risk - Oversight (Ontario)
🏢 Jobtailor
📍 Ontario